Title: Mr. Ms. Dr. Prof. * First Name: * Last Name: Street Address: Town/City: Province/State: Postal Code/Zip Code: * Country: Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belau, Republic of (or Palau) Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire (Netherlands Antilles) Botswana Boznia-Herzegovina Brazil British Indian Ocean Territory Brunei Bulgaria Burkina-Faso Burma (Myanmar, Union of) Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caroline Islands Cayman Islands Central African Republic Chad Channel Islands Chile China (see People’s Republic of China) Christmas Island Colombia Comoros Island Cook Islands Costa Rica Croatia Cuba Curaçao (Netherlands Antilles) Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Easter Island Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia Gabon Gambia Gaza (Palestinian Authority) Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Johnston Atoll Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia (Former Yugoslav Republic of) Madagascar (Republic of) Malawi Malaysia Maldives Mali Malta Mandeira Marianas Marie-Galante Marshall Islands (Republic of the) Martinique Mauritania Mauritius Mexico Micronesia (Federated States of) Midway Island Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar, Union of (Burma) Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau (or Republic of Belau) Palestinian Authority (West Bank and Gaza Strip) Panama Papua New Guinea Paraguay People’s Republic of China Peru Philippines Poland Polynesia, French Portugal (Azores, Madeira) Puerto Rico Qatar Republic of Congo Republic of Madagascar Reunion Romania Russia Rwanda Saba (Netherlands Antilles) Samoa Samoa (American) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia-Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Barthélemy St. Eustatius St. Helena St. Kitts and Nevis St. Lucia St. Maarten/St. Martin (Netherlands Antilles) St. Pierre et Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokeleau Island Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu U.S. Trust Territories of the Pacific Island Uganda Ukraine United Arab Emirates United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British and US) Wake Island Wales Wallis and Futuna West Bank (Palestinian Authority) Western Sahara Yemen Zambia Zimbabwe * E-mail: * Telephone: Nationality: Date of Birth: (YYYY-MM-DD) Current Status in Country of Residence: FACTOR 1 : EDUCATION LEVEL Please indicate your education level:   Post-graduate university studies AND 17 years or more of education 2 or more university diplomas AND a minimum of 15 years of education 1 university diploma (2 years or more of courses) AND a minimum of 14 years of education 1 university diploma (1 year course) AND a minimum of 13 years of education 1 technical certificate (3 years or more of courses) AND a minimum of 15 years of education 1 technical certificate (2 years) AND a minimum of 14 years of education 1 technical certificate (1 year) AND a minimum of 13 years of education 1 technical certificate (1 year) AND a minimum of 12 years of education High school Less than high school FACTOR 2 : LANGUAGE ABILITIES 1ST OPTION ENGLISH FRENCH       None Basic Intermediate Advanced Writing Listening Speaking Reading 2ND OPTION ENGLISH FRENCH       None Basic Intermediate Advanced Writing Listening Speaking Reading FACTOR 3 : AGE Please enter your age in years 54 or more 53 52 51 50 21 to 49 20 19 18 17 16 or less FACTOR 4 : PROFESSIONAL WORK EXPERIENCE Professional experience in the last 10 years More than 4 years 2 years but less than 4 2 years but less than 3 1 year but less than 2 Less than 1 year None FACTOR 5: SPOUSE'S EDUCATION LEVEL Please indicate your spouse's education level Post-graduate studies 1 year or more university diploma 1 year or more post-secondary for technical certificate High school or less No spouse FACTOR 6: WORK/STUDY IN CANADA Have you ever worked in Canada on a valid work permit? (At least one year.) NO YES If yes, how long? Kindly provide details. Have you ever studied in Canada on a valid study permit? (Post-secondary courses only: at least 2 years full-time and over the age of 17 years.) NO YES If yes, how long? Kindly provide details. FACTOR 7: DO YOU HAVE? Do you (or your spouse) have any relative who is a Canadian citizen or permanent resident? NO YES Type of relative: Mother/Father Brother/Sister Uncle/Aunt Other Do you have or can you obtain an Human Resourses and Skills Development Canada-validated job offer? NO YES If yes, please explain below: How did you hear about CILA Immigration Inc.?